Joshua Williams, MD, General Pediatrician, Assistant Professor of Pediatrics, Denver Health Medical Center & The University of Colorado Denver School of MedicineSean T. O'Leary, MD MPH, Associate Professor of Pediatrics, The University of Colorado Denver School of Medicine

Background: Vaccination is one of the most important public health advances of the last century. However, religious vaccine exemptions are increasing, even though most religious traditions support vaccination. The reasons for this trend are unclear. While we know little about religious leaders’ (RLs) attitudes, beliefs, and congregational experiences with vaccines, RLs strive to influence the practices of their faith communities. A 2013 measles outbreak at a large, Evangelical church in Texas may have been associated with its leader’s comments about vaccines. Conversely, public health workers who engaged RLs in a Somali community in Minnesota increased uptake of the measles, mumps, and rubella vaccine during a 2015 measles outbreak. These experiences suggest RLs may have unique insight into rising rates of religious vaccine exemptions.

Objectives:Our primary objective was to describe RLs’ attitudes, practices, and congregational experiences with childhood vaccines. A secondary objective was to identify vaccine hesitant religious leaders (VHRLs) and compare them with non-hesitant RLs.

Methods:We performed a cross-sectional, internet-based survey of RLs from religious organizations (ROs) in Denver, Colorado. Eligible ROs were open, had a working phone number or e-mail address, and had at least one RL (Head, Associate, or Children’s Pastor/Rabbi/Imam or equivalent). ROs were identified through the Association of Religion Data Archives (ARDA) website. The survey included a validated vaccine hesitancy scale, demographic questions, and novel items based on the health belief model. Descriptive and comparative analyses were performed.

Results:Of the 439 listed ROs, 105 were ineligible. The response rate was 33% (109/334). RLs averaged 55+/-13 years old and were predominantly English-speaking, white males who had served >10 years in Protestant ROs; the majority were married and had children. Most RLs asked doctors (61%) for vaccine information, followed by religious leaders, organizations, or texts (21%). 42% of RLs believed their religious texts supported vaccines, 34% disagreed, and the remainder were unsure. Half (54%) agreed with the existence of Colorado’s religious vaccine exemption law. Of RL parents, 22% used an alternative vaccine schedule for their youngest child. Of all RLs, 28% had received vaccine questions from congregants, 18% knew a child who did not get a vaccine for religious reasons, and 10% had spoken formally to their RO about vaccines. 25% of RLs were vaccine hesitant, as defined by their validated vaccine hesitancy scale scores. Vaccine hesitant RLs were less likely to list doctors as a primary source of vaccine information (p < 0.01), more likely to use alternative vaccine schedules (p < 0.01), less likely to believe religious texts support vaccines (p < 0.01), and more likely to support the existence of religious exemption laws (p = 0.04).

Conclusions:RLs are vaccine hesitant and use alternative vaccination schedules on levels comparable with the general population. Many RLs discuss vaccines within their ROs and know individuals who have not received a vaccine for religious reasons. Vaccine advocates should consider engaging RLs as novel partners for vaccine education and uptake. Further research is needed to better understand RLs’ views and assess them on a larger scale.